Mo1081 Effect of a Low-Volume Compared to a High-Volume Polyethylene Glycol Bowel Preparation Solution on Prep Quality, Procedure Times, and Adenoma Detection Rates

Mo1080

prep, the overall magnitude of the difference was sufficiently small that its use was not associated with any clinically meaningful effects on procedure times or the ability to detect adenomas in the proximal or distal colon. If these results can be confirmed, mechanisms to reduce or eliminate barriers that limit its use should be considered given the favorable tolerability profile of Moviprep® with patients.

AGA Abstracts

Underuse of Surveillance Colonoscopy in Ethnic Minorities With a History of Advanced Adenomas: Patient, Provider and System-Level Factors Caitlyn Braschi, Kristen Lee, Brijen Shah, Guy H. Montgomery, Lina Jandorf, Steven H. Itzkowitz Background: Patients with a history of advanced adenomas have an increased risk of developing colorectal cancer, yet low rates of adherence to current surveillance guidelines persist. Targets for interventions that could improve adherence have yet to be identified in multilevel systems of care. Aims: 1) To determine the rate of referral and adherence to 3-year interval surveillance colonoscopy in patients with advanced adenomas. 2) To identify modifiable factors in a multilevel system as possible intervention targets to improve surveillance referral and adherence. Methods: Average-risk, asymptomatic African American and Latino patients ≥50 years of low socioeconomic status (SES) underwent screening colonoscopy (SC) at an urban academic medical center from 2008 to 2010 as part of an IRB-approved study testing the effectiveness of patient navigation to increase SC adherence. Of 642 subjects screened, we identified all patients (N=77) who had pathology findings that warranted a 3-year surveillance colonoscopy: at least 1 advanced adenoma (size ≥1cm, any villous component, high-grade dysplasia, or cancer) or ≥3 adenomas of any type. Electronic medical records were reviewed to determine: surveillance colonoscopy completion rate; documentation of initial pathology in the "Problem List" of the electronic medical record; and timing and nature of visits to a primary care physician (PCP). Results: As shown in the Figure, among the sample, only 13 (16.9%) had a record of surveillance colonoscopy completion. The pathology found at the time of SC was noted under "Problem List" in the charts of 76.9% of completers but in only 32.8% of non-completers (significance p=.005). Among the 64 non-completers, we examined referrals patterns within the 12 months leading up to the surveillance due date and found that 20 patients (31.3%) had no visit in that time frame or since, 35.9% (N=23) had a PCP visit and were not referred, and 32.8% (N=21) had a visit and a referral to either a gastroenterologist consult (N=5) or a surveillance colonoscopy (N=16). These last 21 patients have neither seen the gastroenterologist nor completed the exam. Conclusions: Adherence to 3-year surveillance colonoscopy guidelines was low in an ethnic minority, low SES population with advanced adenomas at an urban academic medical center. Our data suggest possible targets for intervention: a) ensuring that findings are readily available to the PCP (e.g., use of the Problem List); b) developing electronic reminder systems for providers (e.g., email reminders); and, c) encouraging patients to have timely PCP visits and follow-through after colonoscopy referral (e.g., patient navigation). Such enhancements will hopefully increase surveillance referral and adherence, thereby contributing to a decrease in colorectal cancer mortality.

Mo1082 The Effect of Hormonal Contraceptives on Menstrual-Related Inflammatory Bowel Disease Symptoms Lori M. Gawron, Adina R. Goldberger, Andrew J. Gawron, Cassing Hammond, Laurie Keefer Background: Women with inflammatory bowel diseases (IBD) commonly report an increase in their IBD symptoms related to their menstrual cycle. Hormonal contraceptives are used to manage other disorders with cyclical symptoms, such as catamenial seizures or migraines. Hormonal contraceptives are safe in women with IBD and frequently used for reproductive planning, but data is lacking on their effect on IBD-related symptoms. Methods: Female reproductive age Crohn's and ulcerative colitis patients in an academic practice were identified by electronic database query, sent an opt-out letter, and then contacted for phone survey. Questions included demographics, medical and reproductive history, and current/prior contraceptive use. Women were asked if/how their menses affected IBD-related symptoms and if/how their contraceptive affected symptoms. Descriptive statistics were calculated and we used chi square tests for comparisons between women and contraceptive methods on Stata V11 (College Station, TX). Results: 121 female participants (31% response rate) were predominately white (85%), had at least some college education (96%), and a mean age of 34.2 years (SD 6.2y). 60% had Crohn's, 30% had prior IBD-related surgery, 36% were on biologic therapy, and 30% were using an immunomodulator. 43% had at least one child and 58% desire a future pregnancy. Two-thirds (82) currently used a regular contraceptive method. There was no significant difference between the proportions of women reporting menstrual effects on IBD-related symptoms who currently used hormonal contraceptives vs. those who did not (52% vs. 62%). Of the 89 (74%) women with current/prior estrogenbased combined contraceptive use, 22% reported IBD-related symptomatic improvement and 74% had no change in symptoms. 40% of the levonorgestrol intrauterine users had symptomatic improvement [Table 1]. The most frequently reported IBD-related symptoms that improved with hormonal contraceptive use were diarrhea (46%), pain (46%), and cramping (42%) [Table 2]. Conclusion: In a subset of women with IBD, hormonal contraception may be associated with improved cyclical, menstrual-related IBD symptoms. Prospective clinical studies are needed to confirm this and elucidate possible pathophysiologic mechanisms. IBD-related symptoms by type of hormonal contraceptive type in current and past users

Mo1081 Proportion of hormonal contraception users with IBD-related symptom improvement by symptom type (N=26)

Effect of a Low-Volume Compared to a High-Volume Polyethylene Glycol Bowel Preparation Solution on Prep Quality, Procedure Times, and Adenoma Detection Rates Bryan B. Brimhall, Sam C. Hankins, Gregory L. Austin Background/Aims: Low-volume polyethylene glycol (PEG) bowel preps have been shown to be better tolerated by patients in comparison to traditional high-volume bowel preps. However, there is little quantitative data comparing low- and high-volume preps with respect to their effects on prep quality, procedure time, adenoma detection rate (ADR), advanced adenoma detection rate (AADR), and location of detected adenomas. We compared a lowvolume PEG solution (Moviprep®) to a high-volume PEG solution (Colyte®) in regards to the above outcomes. Methods: This is a retrospective cohort study of all outpatient colonoscopies performed during a one-year period at a single academic medical center in which Moviprep® (n=1830) or Colyte (n=1283) was used. Procedures in which another bowel prep was used were excluded (n=18). All preps were split dosed. Linear regression was performed for the outcomes of insertion, withdrawal, and total procedure times. Logistic regression was performed for the outcomes of prep quality (fair/poor), overall ADR, overall AADR, proximal (to the splenic flexure) ADR, proximal AADR, distal ADR, and distal AADR. Models were adjusted for age, gender, fellow participation, the individual attending endoscopist, insurance provider, and whether the colonoscopy was for a diagnostic or screening/surveillance indication. Results: Having a fair/poor bowel prep was associated with a longer mean (+/- S. E.) total procedure time (2.3 +/- 0.7 minutes) and a decrease in the overall ADR (OR 0.75; 95% CI: 0.58-0.96) and proximal ADR (OR 0.68; 95% CI: 0.50-0.93). Although Moviprep® was associated with a small but significant increase in the odds of having a fair/poor bowel prep (OR 1.33; 95% CI: 1.04-1.70) compared to Colyte®, Moviprep® was not associated with differences in insertion (p=0.39), withdrawal (p=0.25), or total procedure times (p= 0.12). The adjusted percentage with a fair/poor prep was 12.6% for patients who used Moviprep and was 9.8% for patients who used Colyte®. Additionally, use of Moviprep® was not associated with a significant difference in the overall ADR (OR 0.94; 95% CI: 0.781.12), the overall AADR (OR 1.16; 95% CI: 0.85-1.59), the proximal ADR (OR 0.95; 95% CI: 0.77-1.18), the proximal AADR (OR 1.57; 95% CI: 0.67-3.71), the distal ADR (OR 0.85; 95% CI: 0.66-1.10), or the distal AADR (OR 0.85; 95% CI: 0.44-1.65). Conclusions: Although Moviprep® was associated with a small increase in odds of having a fair or poor

AGA Abstracts

Mo1083 Assessment of a Colonoscopy Triage Sheet for Use in a Province-Wide Population-Based Colorectal Screening Program Nour Sharara, Maida J. Sewitch, Sabrina Nolan, Myriam Martel, Maria-Helena Dias, Alan N. Barkun Background: Based on guidelines, a colonoscopy triage sheet (CTS) was designed for provincewide use in the Quebec population-based colorectal cancer screening program. The aim of the CTS is to permit equitable and uniform triaging of all patients requiring colonoscopy in the province. The CTS lists a hierarchy of 16 identified indications that are matched to 6 priorities, (symptoms-P1 to P4, average-risk screening-P5, surveillance-P6) with correspondingly increasing target delays for colonoscopy. Aims: 1) To assess the diagnostic yield of the 6 CTS priorities with their prognostic values, 2) to compare the triaging priorities selected by the referring physician on the CTS and by the endoscopist on the endoscopy report, and 3) to determine predictors of agreement of triaging priorities assessed by both

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